Journal of Thrombosis and Thrombolysis

, Volume 46, Issue 3, pp 404–408 | Cite as

Residual vein obstruction in patients diagnosed with acute isolated distal deep vein thrombosis associated with active cancer

  • F. Dentali
  • S. Barco
  • S. Pegoraro
  • M. N. D. Di Minno
  • D. Mastroiacovo
  • F. Pomero
  • C. Lodigiani
  • F. Bagna
  • M. Sartori
  • G. Barillari
  • N. Mumoli
  • M. Napolitano
  • S. M. Passamonti
  • R. Benedetti
  • W. Ageno
  • M. Di Nisio


After acute proximal deep vein thrombosis (DVT) the thrombotic mass decreases, especially during the first months of anticoagulation. The persistence of residual vein obstruction (RVO) may predict future recurrence in patients with cancer-associated DVT. We aimed to evaluate the proportion of patients with RVO after an episode of cancer associated isolated distal DVT (IDDVT), to identify variables associated with RVO, and to provide initial evidence of its association with recurrent VTE. We performed a post-hoc analysis of a multicenter cohort study of patients with isolated cancer-associated acute IDDVT. We included patients who underwent a control ultrasonography at the end of the anticoagulant treatment between day 30 and day 365 after index IDDVT, given that no recurrent VTE had already occurred on anticoagulant treatment. A total of 153 patients had ultrasonographic follow-up after a median of 92 days from index IDDVT: 45.8% had RVO and 54.2% exhibited complete recanalization. Female sex, Body Mass Index > 30 Kg/m2 and involvement of axial calf veins showed the strongest association with RVO. The risk of recurrence was twofold higher in patients with (versus without) RVO. RVO persisted in approximately half of patients with an episode of cancer-associated IDDVT at anticoagulant discontinuation. Patients with RVO appeared to be at a higher risk for recurrent events.


Distal deep vein thrombosis Residual vein obstruction Compression ultrasound Venous thromboembolism Recurrence 



The patients included in this study were followed at 12 Italian centers (Varese, Naples, Avezzano, Cuneo, Rozzano, Bologna, Udine, Livorno, Palermo, Milan, Piacenza, Chieti). The present study was not funded.The work of Stefano Barco is supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and 01EO1503).

Author contributions

FD and MDN were responsible for the concept and design of the study. FD, MDN, SP, MNDDM, DM, FP, CL, FB, MS, GB, NM, MN, SMP, RB, and WA were responsible for acquisition of data. FD, SB, NM, MDN, MNDDM, and WA were responsible for database handling and updating. SB was responsible for statistical analysis. SB, FD, and MDN were responsible for drafting the manuscript and for interpretation of results. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, and provided final approval.

Compliance with ethical standards

Conflict of interest

The corresponding author states that there are no potential conflicts of interest to disclose.

Ethical approval

This research study has been performed according to the general principles of the Declaration of Helsinki (General Assembly, Helsinki, Finland, June 1964), on ethical principles for medical research involving human subjects.

Informed consent

Informed consent to use their medical information was obtained by all patients included in the study at the time of DVT diagnosis.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical and Experimental MedicineInsubria UniversityVareseItaly
  2. 2.Center for Thrombosis and HemostasisUniversity Medical Center of the Johannes Gutenberg UniversityMainzGermany
  3. 3.Unit of Cardiology, Department of Advanced Biomedical SciencesFederico II UniversityNaplesItaly
  4. 4.Angiology UnitAvezzano HospitalAvezzanoItaly
  5. 5.Department of Internal MedicineS. Croce e Carle General HospitalCuneoItaly
  6. 6.Thrombosis CenterIRCCS Istituto Clinico HumanitasRozzanoItaly
  7. 7.Department of Angiology and Blood CoagulationS. Orsola-Malpighi University HospitalBolognaItaly
  8. 8.Center for Haemorrhagic and Thrombotic DisordersUdine General and University HospitalUdineItaly
  9. 9.Department of Internal MedicineOspedale Giuseppe FornaroliMagentaItaly
  10. 10.Haemophilia and Thrombosis Center, Haematology DepartmentUniversity of PalermoPalermoItaly
  11. 11.A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore PoliclinicoMilanItaly
  12. 12.Haemostasis and Thrombosis Center, Department of Internal MedicineHospital of PiacenzaPiacenzaItaly
  13. 13.Department of Medicine and Ageing SciencesUniversity “G. D’Annunzio” of Chieti-PescaraChietiItaly

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